Abstract
Objectives
To examine the interrelationships among low serum albumin, nutritional depletion, and ongoing inflammation in older patients recovering from illness.
Design A prospective cohort study
Setting
A transitional care unit (TCU) within a Department of Veterans Affairs hospital nursing home care unit.
Participants
275 older veterans (mean age=78.9 ± 7.5y, 99% male) admitted for recuperative care and rehabilitation.
Measurements
At admission and discharge (median LOS 24d, IQR 16 to 44d), each subject completed a comprehensive standardized evaluation including a nutritional assessment and measurement of serum albumin, C-reactive protein (CRP), interleukin-6 (IL-6) and its soluble receptor, and tumor necrosis factoralpha (TNF-α) and its soluble receptors (sTNF-RI and II). Complete nutrient intake assessments (calorie counts) were performed daily.
Results
Both the discharge albumin and the change in albumin (discharge minus admission) were strongly and inversely correlated with various indicators of inflammation, particularly CRP and IL-6. Change in CRP was the strongest correlate of change in albumin (R2 = 0.21, P<.001) and discharge IL-6 the strongest correlate of discharge albumin (R2 = 0.21, P<.001). Nutrient intake also correlated with albumin and its change, but entered the multivariable models after inflammatory indicators and explained a smaller portion of the variance. Although there were significant interactions between time and both nutrient intake and inflammation, the relative importance of inflammation as a potential determinant of the serum albumin concentration appeared to remain unchanged with longer periods of observation.
Conclusions
Among elderly patients admitted to a TCU, inflammation appears to be a more powerful determinant of albumin and its change during the hospitalization than is nutrient intake. Further study is needed to prove causality and to determine whether the relative importance of inflammation on the albumin concentration diminishes with more prolonged periods of observation.
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References
Kane RL, Finch M, Blewett L, Chen Q, Burns R, Moskowitz M. Use of post-hospital care by Medicare patients. J Am Geriatr Soc 1996;44:242–250.
Campbell I, Case C. Patient management in the subacute unit. Lippincott’s Primary Care Practice 1999;3:231–241.
Sullivan DH, Walls RC. The risk of life-threatening complications in a select population of geriatric patients: The impact of nutritional status. J Am Coll Nutr 1995;29-36.
Forse RA, Shizgal HM. Serum albumin and nutritional status. JPEN J Parenter Enteral Nutr 1980;4:450–454.
Sullivan DH, Roberson PK, Johnson LE et al. Association between inflammation-associated cytokines, serum albumins, and mortality in the elderly. Journal of the American Medical Directors Association 2007;8:458–463.
Doweiko JP, Nompleggi DJ. The role of albumin in human physiology and pathophysiology, Part III: Albumin and disease states. JPEN J Parenter Enteral Nutr 1991;15:476–483.
Rothschild MA, Oratz M, Schreiber SS. Serum albumin. Hepatology 1988;8:385–401.
Sullivan DH, Patch GA, Walls RC, Lipschitz DA. Impact of nutrition status on morbidity and mortality in a select population of geriatric rehabilitation patients. Am J Clin Nutr 1990;51:749–758.
Baden AL, Cain CM, Sullivan DH. Impact of computer based nutrient analysis system on reducing time for obtaining calorie counts. J Am Diet Assoc 1992;92.
Harris JA, Benedict FG. Biometric Studies of Basal Metabolism in Man. Carnegie Institute of Washington 1919.
Campbell WW, Crim MC, Dallal GE, Young VR, Evans WJ. Increased Protein Requirements in Elderly People: New data and retrospective reassessments. Am J Clin Nutr 1994;60:501–509.
Aderka D, Engelmann H, Wysenbeek AJ et al. The possible role of tumor necrosis factor (TNF) and its natural inhibitors, the soluble-TNF receptors, in autoimmune diseases. Isr J Med Sci 1992;28:126–130.
Sacheck JM, Cannon JG, Hamada K, Vannier E, Blumberg JB, Roubenoff R. Agerelated loss of associations between acute exercise-induced IL-6 and oxidative stress. Am J Physiol Endocrinol Metab 2006;291:E340–E349.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987;40:373–383.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW, Cleveland MA. Studies of Illness in the Aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185 No. 12:914–919.
Malave I, Vethencourt MA, Pirela M, Cordero R. Serum levels of thyroxine-binding prealbumin, C-reactive protein and interleukin-6 in protein-energy undernourished children and normal controls without or with associated clinical infections. J Trop Pediatr 1998;44:256–262.
Memoli B, Minutolo R, Bisesti V et al. Changes of serum albumin and C-reactive protein are related to changes of interleukin-6 release by peripheral blood mononuclear cells in hemodialysis patients treated with different membranes. Am J Kidney Dis 2002;39:266–273.
Bernstein L. Measurement of visceral protein status in assessing protein and energy malnutrition: standard of care. Prealbumin in Nutritional Care Consensus Group. Nutrition 1995;11:169–171.
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Sullivan, D.H., Johnson, L.E., Dennis, R.A. et al. The interrelationships among albumin, nutrient intake, and inflammation in elderly recuperative care patients. J Nutr Health Aging 15, 311–315 (2011). https://doi.org/10.1007/s12603-010-0297-1
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DOI: https://doi.org/10.1007/s12603-010-0297-1